Provider Demographics
NPI:1538300785
Name:BRADY, JACQUELINE S (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:BRADY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 ALPHA RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4506
Mailing Address - Country:US
Mailing Address - Phone:972-386-6200
Mailing Address - Fax:972-386-9524
Practice Address - Street 1:5408 ALPHA RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4506
Practice Address - Country:US
Practice Address - Phone:972-386-6200
Practice Address - Fax:972-386-9524
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX210291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice